NPIMap

Organization Active NPI

Southern Urology, LLC

  • Urology Physician
  • Lafayette, LA
National Provider Identifier
1740441955
Registry record updated Jul 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
SOUTHERN UROLOGY, LLC
Practice address
120 Rue Louis Xiv BLDG 2
Lafayette, LA 70508-5739
Phone
(337) 769-7779
Fax
(337) 769-7800
NPI assigned
Jun 19, 2008
Last updated
Jul 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark R Eldredge
Title
Manager
Phone
(337) 769-7779

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X NU Primary

Addresses

Primary practice location

120 Rue Louis Xiv BLDG 2
Lafayette, LA 70508-5739

Mailing address

120 Rue Louis Xiv BLDG 2
Lafayette, LA 70508-5739
Phone (337) 769-7779

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081002000001 LA Part B Supplier - Clinic/Group Practice 5597833772 Receives reassigned benefits from 29 practitioners
Practice locations: Abbeville, LA; Crowley, LA; Lafayette, LA; New Iberia, LA; Opelousas, LA; Ville Platte, LA
O20230215003207 LA DME Supplier - Physician - Urology 5597833772 Practice locations: Lafayette, LA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

1000 W Pinhook Rd
Ste 304
Lafayette, LA 70503
Phone (337) 289-9155

120 Rue Louis Xiv
Bldg 2
Lafayette, LA 70508
Phone (337) 233-6665

200 Beaullieu Dr
Ste 7
Lafayette, LA 70508
Phone (337) 232-4555

Interoperability endpoints

  • Direct secure messaging: alaynadunbar@southernuro.medalliesdirect.net
  • Direct secure messaging: alexfuselier@southernuro.medalliesdirect.net
  • Direct secure messaging: andrebroussard@southernuro.medalliesdirect.net
  • Direct secure messaging: christopherfontenot@southernuro.medalliesdirect.net
  • Direct secure messaging: edwardbreaux@southernuro.medalliesdirect.net
  • Direct secure messaging: jasonbourque@southernuro.medalliesdirect.net
  • Direct secure messaging: jeannettechassaignac@southernuro.medalliesdirect.net
  • Direct secure messaging: jeffreythibodeaux@southernuro.medalliesdirect.net
  • Direct secure messaging: jeremyspeeg@southernuro.medalliesdirect.net
  • Direct secure messaging: johnvallee@southernuro.medalliesdirect.net
  • Direct secure messaging: lauraowens@southernuro.medalliesdirect.net
  • Direct secure messaging: marcelluslahaye@southernuro.medalliesdirect.net
  • Direct secure messaging: michaelhoss@southernuro.medalliesdirect.net
  • Direct secure messaging: samuelshuffler@southernuro.medalliesdirect.net
  • Direct secure messaging: scottneusetzer@southernuro.medalliesdirect.net
  • Direct secure messaging: sethguilbeau@southernuro.medalliesdirect.net
  • Direct secure messaging: thadbourque@southernuro.medalliesdirect.net
  • Direct secure messaging: williamroth@southernuro.medalliesdirect.net

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 30

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721174400000",
    "number": "1740441955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 RUE LOUIS XIV BLDG 2",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-769-7779",
            "fax_number": "337-769-7800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 RUE LOUIS XIV BLDG 2",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-769-7779",
            "fax_number": "337-769-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN UROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-19",
        "last_updated": "2024-07-17",
        "certification_date": "2024-07-17",
        "status": "A",
        "authorized_official_last_name": "ELDREDGE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "337-769-7779",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.